Integrating Endoscopy in the Technological Environment of the Modern Neurosurgical Operating Room

Abstract

The evolution of endoscopic techniques and the development of useful endoscopes as well as supplementary working instruments have improved surgical results and expanded indications for neuroendoscopy. The design of modern microprocessor-controlled solid-state coagulating and cutting devices has been another milestone to establish this technique in daily operative routine. Furthermore, intraoperative fluoroscopy, three-dimensional approach planning using digital fluoroscopy, CCT or MRI stereotactic guidance and neuronavigation and intraoperative MRI offer a high grade of safety and precision. Thin laser probes and ultrathin bare laser fibres and intraluminal ultrasonic probes can be used either for different purposes in endoscopic neurosurgery. For the future ultrasound-navigated neuroendoscopy through a burr hole could also be an option in diagnosis and treatment of hydrocephalus. All these components have contributed to make neuroendoscopic interventions acceptable as an alternative treatment option in well-defined indications. A new and very sophisticated technique, which will become available in the future, will integrate the third dimension into neuroendoscopes. These endoscopes will give a high quality of field of depth and will provide a higher level of accuracy for neuroendoscopic interventions.

Today, after a long developmental period, endoscopy is well integrated in the environment of the modern neurosurgical operating room. However, these technologies are cost-intensive and very sensitive and tend to break. Knowledge of the endoscopic topographical anatomy and the availability of basic and useful instruments are therefore indispensable prerequisites.